Study: Increasing number of hospital beds won't solve overcrowding
"Conversations with physicians have revealed that they feel additional hospital beds will not significantly change the situation, and that what needs to change are hospitalization procedures."
By EYTAN HALONDoctors treat internal medicine ward patients in Israeli hospital corridors(photo credit: Courtesy)
Significant changes to hospitalization procedures are required to tackle overcrowding in Israel’s hospitals, rather than simply increasing the number of hospital beds, according to a study published on Thursday by the Taub Center for Social Policy in Israel.“Systemic failures” in government planning, budgeting and regulation have led to increasing pressure on institutions and long waiting times for the 1.1 million people treated annually in Israel’s 44 general hospitals, according to the report.These failures, the report says, have resulted in a lower number of beds per population relative to OECD countries, inefficiencies due to hospital size and geographic dispersion, gaps in accessibility to hospitals between central Israel and peripheral areas and high bed occupancy rates.The number of hospital beds per 1,000 inhabitants stands at 2.2 beds, compared to 3.6 on average among OECD members and 4.2 in European countries with similar healthcare systems to Israel.While the ratio is declining internationally as a result of population growth, the number of Israeli hospital beds per 1,000 inhabitants decreased by 22% between 2002 and 2017, compared to 15% in the OECD and 20% in similar European countries.The average number of hospital beds is particularly low in the country’s geographic periphery, with just 1.32 beds in the North and 1.55 beds in the South per 1,000 inhabitants. Jerusalem hospitals have the most beds, with 2.36 per 1,000 inhabitants.Also concerning, the report said, is decreasing spending on hospitalization by the government. Hospitalization expenditure declined from 43.3% of government health funding to 32.6% in 2014. In total, Israel spends approximately 1.9% of its GDP annually – or about NIS 3,700 per citizen – on funding hospitalizations, below the OECD average of 2.3%.Disparities in hospital beds between the center and periphery are compounded by distances to hospitals for relatively routine medical treatment.In the North, the average distance to a hospital is more than 19 km., followed by 18 km. in the West Bank and 16 km. in the South. The average distance in Tel Aviv and Jerusalem is approximately 3-4 km.For more complex treatments at regional medical centers, residents of the North need to travel 45 km. and residents of the South must travel 41 km. on average. Residents of Tel Aviv and Jerusalem need only travel approximately 4 km.“Conversations with physicians have revealed that they feel additional hospital beds will not significantly change the situation, and that what needs to change are hospitalization procedures in order to reduce pressure on the hospitals and waiting times for patients,” said Prof. Dov Chernichovsky and Roi Kfir, the authors of the report.Recommended procedural changes included avoiding unnecessary hospitalizations by discharging patients from emergency rooms; moving physicians to two shifts in hospital departments rather than a single shift; patient check-ups in evening hours and weekends to reduce hospitalization time; evaluating the efficacy of home hospitalization; and physician consultations to old-age facilities to avoid hospitalizations.“The addition of curative hospital beds – that are efficient and accessible – is inevitable within the next few years, even considering technological advances that allow expansion of services given in the community setting,” the authors said.“Before additional investments in the system are made, though, it is worthwhile to reduce the government’s involvement in the marketplace.”Last week, the Health Ministry committed to putting an end to patients lying in hospital ward corridors within five years.The pledge came after a ministry committee submitted recommendations to improve hospitalization in internal medicine wards across the country’s hospitals.Slamming corridor hospitalizations as “unacceptable” and constituting a “violation of human dignity and the basic right to privacy,” the committee chaired by Prof. Ran Tur-Kaspa recommended that the Health Ministry director-general issue a directive prohibiting the hospitalization of patients outside hospital wards or rooms within five years.In order to implement the directive, the committee recommended allocating a dedicated multi-year budget for the renovation, construction and adaptation of internal medicine wards.The committee also recommended increasing the medical staff allocated to each ward – making hospital discharge procedures more efficient – and encouraging young doctors to see internal medicine wards as their professional home and training them to become experienced department managers.
